Major haemorrhage following a transjugular liver biopsy: a case report and a discussion of complications and learning points

Abstract

Liver biopsy can be performed percutaneously, or via a transjugular approach. Transjugular liver biopsy (TJLB) is usually used in patients who are suffering from severe coagulation disorders (prolonged prothrombin time or low platelets), ascites, severe obesity, or failure of a previous non-targeted percutaneous liver biopsy. In TJLB, the biopsy needle is inserted into the liver parenchyma via the hepatic vein, avoiding transgression of the hepatic capsule and peritoneum. Unlike a percutaneous biopsy, a transjugular approach reduces the risk of bleeding as any bleeding from the biopsy site should be returned into the venous system. It is a safe, well-tolerated procedure, with a major complication rate of less than 0.6%. This case report describes the rare occurrence of a severe intraperitoneal haemorrhage post-TJLB, and describes and discusses the technique, complication profile, and learning points from this complication.